Shavon Arline-Bradley, MPH Health Equity = Dollars & Sense Health Equity & Economics A Social Justice Issue A dvocacy C ommunity Mobilization & Educ. T raining

2 During this Session, participants will: Identify systemic issues and contributing factors that increase the rates of disease in communities of color (special emphasis on the Black community); Discuss a historical perspective of health inequity and the absence of culturally competency in health promotion activities including research Understand the role of structural racism in health and opportunities for equity and economic development. Review the integral role of researchers to develop relevant research opportunities for communities of color and the need to improve in the area of inclusion. Session Objectives

3 Quote from Dr. Martin Luther King, Jr. Of all forms of inequality, injustice in health care is the most shocking and inhumane. --- Rev. Dr. Martin Luther King, Jr.

4 Quote from W.E.B. DuBois “ One thing of course we must expect to find, and that is a much higher death rate at present among Negroes than among Whites: this is one measure of the difference in their social advancement”  In 1899, W. E. B. DuBois wrote in the Philadelphia Negro, A Social Study.  A Founder of the NAACP Body & Soul: Black Panthers  Health & Physique Pub  Dubois Disputes Black Inferiority

History Repeating Itself – Healthcare Uncovers The Truth …

6 History Repeating Itself..

7 Reasons to fight for Health Equity? Signs of Racism

8

Structural Racism

10 Structural Racism Center for Social Inclusion - Maya Wiley Core of Structural Inequality?  Structural arrangements produce disparities  If policy is the root of the problem, it is also the place to find a solution. EXAMPLE : A bank chooses where branches will open and who it will lend to. A business decides to locate where labor is plentiful and taxes are low. A local government decides to cut funding for public transit to address a budget shortfall TRUTH: Communities will not prosper when they have fewer banks, little access to credit for homes and businesses, and longer, more expensive commutes to get to jobs.

11 Structural Racism Collectively, decisions like these structure the world we live in and determine what opportunities and challenges we face. Decent housing, quality healthcare and good schools, is helped or hindered by decisions. Too often the impact of these decisions comes at the expense of communities of color. SOLUTION – Work together to build a vibrant and opportunity- rich society. Policies that explicitly address the needs of communities of color will build a healthier society that improves the well-being of us all.

12 Unequal Treatment – IOM Report Evaluation of sources of health disparities, including the role of discrimination, bias and stereotyping at the individual (provider/patient), institutional and health care systems level Assess the extent of racial and ethnic differences in healthcare that are not otherwise attributable to otherwise known factors such as access to care Recommendations regarding interventions to eliminate disparities  5 Interventions: Systemic Strategies ( ) 5 Interventions: Systemic Strategies ( )  Assessing Potential Sources of Racial and Ethnic Disparities in Care: Patient- and System-Level Factors ( ) Assessing Potential Sources of Racial and Ethnic Disparities in Care: Patient- and System-Level Factors ( )  The Civil Rights Dimension of Racial and Ethnic Disparities in Health Status - Thomas E. Perez ( ) The Civil Rights Dimension of Racial and Ethnic Disparities in Health Status - Thomas E. Perez ( ) Brian D. Smedley, Adrienne Y. Stith, and Alan R. Nelson et al.

Equity and Power

14 Dual Forms of Bias Individual Bias Acts of Discrimination Racial Profiling Denying an Individual Coverage Institutional Bias Health Inequities Policy, System, Environmental Changes Cultural competency in healthcare

15 Dual Forms of Bias: Altering Power Relations Individual Bias Direct Service Self Help Education Advocacy Direct Action Institutional Bias Education Advocacy Direct Action Is your Research, Public health work and legislation changing institutions and/or structures?

Social Determinants of Health

17 WHO- Commission Recommendations 2008 Improve Living Conditions Tackle Inequitable Distribution of Power Money and Resources Measure and Understand Problem and Assess the Impact of Action

18 Socio-Ecological Framework

19 Socio-Ecological Framework The Socio socio-ecological model recognizes the interwoven relationship that exists between the individual and their environment. The “top-down-up effect” of the socio ecological framework (McLeroy et al., 1988; Stokols, 1996) establishing that environmental effects and shapes behavior. While individuals are responsible for instituting and maintaining the lifestyle changes necessary to reduce risk and improve health, individual behavior is determined to a large extent by social environment,  Community Norms and Values,  Regulations  Policies.

Group Activity: What’s Going on? See It.. Say It!

21 Activity: What’s Going On? What are your community or institution’s “ISMS”?  Community Based Public Health  Academic Institutions – Health Research  Hospitals Where do these “ISMS” derive from? What is the “Root”? How are these “ISMS” affecting the health of the communities you are working in? or affecting you and your ability to effectively change the health outcomes of African Americans- Afro Caribbeans?

22 Activity #2: Force Field Analysis Driving Forces Restraining Forces Health Equity & Economic Equality

23 Barriers to Effective PH Practice -USVI Public Health Issues & Implementation Barriers  Limitations on Reported and Available Data  Health Equity – Magnitude of Disparities  Research Funding & Grant Availability (ECONOMICS)  Academic vs. Community Based Interventions Equity in Public Health Sector  Black Researcher’s Solitude “Intra”racial Dynamics  Class (SES), Education, Geography

Solutions: Policy Change, People Power and “Pocketbooks”

Policy as a Solution

26 Policy as a Solution If policy is the root of the problem, it is also the place to find a solution. Public Policy is a system of laws, regulatory measures, course of action, and funding priorities set by a governmental entity or its representatives (Childhood Obesity Advocacy Manual, 2011). Type of neighborhood we live in, type of food served in schools, PA opportunities offered in schools Public PolicyPolicy Laws passed by state, federal, elected officials Regulations that guide local agencies, organizations, such as non-profits or colleges VS.

NAACP Childhood Obesity Advocacy Manual Released: September 2011

People Power – “If Not You then Who?”

29 People Power

30 People Power Power to the People … was never a pun. Relevant to mentoring new African American and Afro-Caribbean public health leaders in research, prevention, evaluation Individual and Community Empowerment Power  In your research intervention work, you have to create a “Power pendulum shift”  Support sustainable individual interventions and engage with thought leaders, government and other sectors to ensure they recognize where the power lies,

“Pocketbooks”- Economic Power Strategy

32 Economic Development Engage Non- Tradition Partners – Business Community  Chambers of Commerce, Business Developers  Change “Rules of Engagement” (expand your partner base, COC) “Health & Wealth Phenomenon”  Property Value  Sale of the Community’s Wellness Champions Representing Local & State Government  Budget Cuts  Cost Benefit Analysis

Justice for Generations

“Courage will not skip this generation.. “ Roslyn M. Brock NAACP Chairman

35 NAACP Contact Information Shavon L. Arline-Bradley, MPH  Director, Health Programs  